The Situation of Antibiotic Resistance in Klebsiella Pneumoniae and Carbapenemase-Producing Klebsiella Pneumoniae in Vietnam: A Cross-Sectional Study
DOI:
https://doi.org/10.31584/jhsmr.2023964Keywords:
antibiotic resistance, carbapenem resistance, carbapenemase-producing klebsiella pneumoniae, klebsiella pneumoniae, VietnamAbstract
Objective: Klebsiella pneumoniae (K. pneumoniae) is one of the most prevalent human pathogens. Carbapenemaseproducing klebsiella pneumoniae (CPKP) has recently developed significant antibiotic resistance, not just to carbapenem antibiotics but also to the majority of other currently available antibiotics. Prior to this point, there have been few international studies or publications on the situation of CPKP in Vietnam. Hence, this study was conducted to determine the antibiotic resistance of K. pneumoniae and CPKP strains in Can Tho, Vietnam.
Material and Methods: In total, 345 K. pneumoniae strains were isolated. Antibiotic susceptibility was assessed via an automated microbiological system. A modified carbapenem inactivation assay was applied to identify CPKP strains, followed by the use of the MASTDISCS combi Carba plus disc system to classify certain carbapenemases.
Results: Of the 345 K. pneumoniae strains, 110 represented an isolation rate of 31.9%. There was a significant correlation (p-value<0.05) between the specimen type, hospital unit and CPKP ratio. All the examined CPKP strains exhibited complete resistance to penicillin and cefazolin. The CPKP strains were also significantly more resistant to PTZ, cefepime, ciprofloxacin and imipenem than the non-CPKP strains (p-value<0.05). Amikacin, gentamicin and TMP/SMX have been shown to be effective in treating patients infected with CPKP strains.
Conclusion: CPKP accounts for 31.9% of all K. pneumoniae infections. K. pneumoniae and CPKP exhibited the highest levels of resistance to ampicillin, cefazoline, ciprofloxacin, ceftriaxone and ceftazidime. Amikacin, gentamicin and TMP/SMX were the least resistant antibiotics tested.
References
Ashurst JV, Dawson A. Klebsiella pneumoniae. Florida: StatPearls; 2022.
Navon-Venezia S, Kondratyeva K, Carattoli A. Klebsiella pneumoniae: a major worldwide source and shuttle for antibiotic resistance. FEMS Microbiol Rev 2017;41:252-75.
Tran HD, Bach Nguyen YT, Thanh Tran T, Thu Le TT, Thu Nguyen HT, Minh Nguyen C, et al. Community-acquired pneumonia-causing bacteria and antibiotic resistance rate among Vietnamese patients: a cross-sectional study. Medicine (Baltimore) 2022;101:e30458.
Murray CJL, Ikuta KS, Sharara F, Swetschinski L, Robles Aguilar G, Gray A, et al. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet 2022;399:629-55.
Lin Z, Yu J, Liu S, Zhu M. Prevalence and antibiotic resistance of klebsiella pneumoniae in a tertiary hospital in Hangzhou, China, 2006–2020. J Int Med Res 2022;50:03000605221079761.
Padmini N, Ajilda AAK, Sivakumar N, Selvakumar G. Extended spectrum β-lactamase producing escherichia coli and klebsiella pneumoniae: critical tools for antibiotic resistance pattern. J Basic Microbiol 2017;57:460-70.
Do Tran H, Trung Nguyen B, Quang Tran H, Gia Tran H. A cross-sectional study of the antibiotic resistant prevalence of ESBL-producing enterobacteriaceae in Vietnam. J Health Sci 2022;12:184-8.
Grundmann H, Glasner C, Albiger B, Aanensen DM, Tomlinson CT, Andrasević AT, et al. Occurrence of carbapenemaseproducing klebsiella pneumoniae and escherichia coli in the European survey of carbapenemase-producing enterobacteriaceae (EuSCAPE): a prospective, multinational study. Lancet Infect Dis 2017;17:153-63.
Ghotaslou R, Sadeghi MR, Akhi MT, Hasani A, Asgharzadeh M. Prevalence and antimicrobial susceptibility patterns of ESBL, AmpC and carbapenemase-producing enterobactericeae isolated from hospitalized patients in Azerbaijan, Iran. Iran J Pharm Res 2018;17(Suppl):79-88.
Dortet L, Cuzon G, Ponties V, Nordmann P. Trends in carbapenemase-producing enterobacteriaceae, France, 2012 to 2014. Euro Surveill 2017;22:30461.
Shimasaki T, Seekatz A, Bassis C, Rhee Y, Yelin RD, Fogg L, et al. Increased relative abundance of carbapenemaseproducing klebsiella pneumoniae within the gut microbiota is associated with risk of bloodstream infection in long-term acute care hospital patients. Clin Infect Dis 2019;68:2053-9.
Wang Q, Wang X, Wang J, Ouyang P, Jin C, Wang R, et al. Phenotypic and genotypic characterization of carbapenemresistant enterobacteriaceae: data from a longitudinal large-scale CRE study in China (2012-2016). Clin Infect Dis 2018;67(Suppl 2):S196-205.
Quoc Trung N, Thai Binh P, Phuong Linh V, Minh Nga C. Surveying in vitro effectively in combination with some antibiotics against multidrug-resistant of escherichia coli and klebsiella pneumoniae. Ho Chi Minh City J Med 2019;23:100-6.
Truong Phu D, Ngoc Cua L, Vinh Nien L, Van Mai D. Current situation of antibiotic resistance of klebsiella pneumoniae at Can Tho Central General Hospital in 2019. Can Tho J Med Pharm 2020;30:115-21.
Thai Duong V, Hoang Long D, Thi Dieu Hien N. Study on Wide-spectrum β-lactamase-producing escherichia coli Isolated at Can Tho Central General Hospital. Vietnam Med J 2022;518:87-91.
Ombelet S, Barbé B, Affolabi D, Ronat J-B, Lompo P, Lunguya O, et al. Best practices of blood cultures in low- and middleincome countries. Front Med (Lausanne) 2019;6:131.
Karah N, Rafei R, Elamin W, Ghazy A, Abbara A, Hamze M, et al. Guideline for urine culture and biochemical identification of bacterial urinary pathogens in low-resource settings. Diagnostics (Basel) 2020;10:832.
Popova G, Boskovska K, Arnaudova-Danevska I, Smilevska-Spasova O, Jakovska T. Sputum quality assessment regarding sputum culture for diagnosing lower respiratory tract infections in children. Open Access Maced J Med Sci 2019;7:1926-30.
Schumacher SG, Wells WA, Nicol MP, Steingart KR, Theron G, Dorman SE, et al. Guidance for studies evaluating the accuracy of sputum-based tests to diagnose tuberculosis. J Infect Dis 2019;220(Suppl 3):S99-107.
Giuliano C, Patel CR, Kale-Pradhan PB. A guide to bacterial culture identification and results interpretation. P T 2019;44:192-200.
Clinical and Laboratory Standards Institute. Preformance standards for antimicrobial susceptibility testing; Thirty infomational supplement, M100-S30. 30th ed. Pennsylvania: Clinical and Laboratory Standards Institute; 2020.
European Centre for Disease Prevention and Control (ECDC). Laboratory manual for carbapenem and colistin resistance detection and characterisation for the survey of carbapenemand/or colistin-resistant Enterobacteriaceae, Version 2.0. Stockholm: ECDC; 2019.
Nirwati H, Sinanjung K, Fahrunissa F, Wijaya F, Napitupulu S, Hati VP, et al. Biofilm formation and antibiotic resistance of klebsiella pneumoniae isolated from clinical samples in a tertiary care hospital, Klaten, Indonesia. BMC Proc 2019;13(Suppl 11):20.
Müller-Schulte E, Tuo MN, Akoua-Koffi C, Schaumburg F, Becker SL. High prevalence of ESBL-producing klebsiella pneumoniae in clinical samples from central Côte d’Ivoire. Intl J Infect Dis 2020;91:207-9.
Wang C, Yuan Z, Huang W, Yan L, Tang J, Liu CW. Epidemiologic analysis and control strategy of klebsiella pneumoniae infection in intensive care units in a teaching hospital of People’s Republic of China. Infect Drug Resist 2019;12:391-8.
Cao Z, Yue C, Kong Q, Liu Y, Li J. Risk factors for a hospital-acquired carbapenem-resistant klebsiella pneumoniae bloodstream infection: a five-year retrospective study. Infect Drug Resist 2022;15:641-54.
Zhang J, Li D, Huang X, Long S, Yu H. The distribution of k. pneumoniae in different specimen sources and its antibiotic resistance trends in Sichuan, China From 2017 to 2020. Front Med (Lausanne) 2022;9:759214.
Jeong SH, Kim HS, Kim JS, Shin DH, Kim HS, Park MJ, et al. Prevalence and molecular characteristics of carbapenemaseproducing enterobacteriaceae from five hospitals in Korea. Ann Lab Med 2016;36:529-35.
Shimasaki T, Seekatz A, Bassis C, Rhee Y, Yelin RD, Fogg L, et al. Increased relative abundance of klebsiella pneumoniae carbapenemase-producing klebsiella pneumoniae within the gut microbiota is associated with risk of bloodstream infection in long-term acute care hospital patients. Clin Infect Dis 2019;68:2053-9.
Pfeifer Y, Cullik A, Witte W. Resistance to cephalosporins and carbapenems in Gram-negative bacterial pathogens. Int J Med Microbiol 2010;300:371-9.
Sarowska J, Choroszy-Krol I, Jama-Kmiecik A, Maczynska B, Cholewa S, Frej-Madrzak M. Occurrence and characteristics of carbapenem-resistant klebsiella pneumoniae strains isolated from hospitalized patients in Poland-a single centre study. Pathogens 2022;11:859.
Logan LK, Weinstein RA. The epidemiology of carbapenemresistant enterobacteriaceae: the impact and evolution of a global menace. J Infect Dis 2017;215(suppl 1):S28-36.
Messaoudi A, Mansour W, Jaidane N, Chaouch C, Boujaâfar N, Bouallègue O. Epidemiology of resistance and phenotypic characterization of carbapenem resistance mechanisms in klebsiella pneumoniae isolates at Sahloul University Hospital-Sousse, Tunisia. Afr Health Sci 2019;19:2008-20.
Al-Zalabani A, AlThobyane OA, Alshehri AH, Alrehaili AO, Namankani MO, Aljafri OH. Prevalence of klebsiella pneumoniae antibiotic resistance in Medina, Saudi Arabia, 2014-2018. Cureus 2020;12:e9714.
Oliveira R, Castro J, Silva S, Oliveira H, Saavedra MJ, Azevedo NF, et al. Exploring the antibiotic resistance profile of clinical klebsiella pneumoniae isolates in Portugal. Antibiotics (Basel) 2022;11:1613.
Uzairue LI, Rabaan AA, Adewumi FA, Okolie OJ, Folorunso JB, Bakhrebah MA, et al. Global prevalence of colistin resistance in klebsiella pneumoniae from bloodstream infection: a systematic review and meta-analysis. Pathogens 2022;11:1092.
Chiu SK, Ma L, Chan MC, Lin YT, Fung CP, Wu TL, et al. Carbapenem nonsusceptible klebsiella pneumoniae in Taiwan: dissemination and increasing resistance of carbapenemase producers during 2012-2015. Sci Rep 2018;8:8468.
Okanda T, Haque A, Koshikawa T, Islam A, Huda Q, Takemura H, et al. Characteristics of carbapenemase-producing klebsiella pneumoniae isolated in the intensive care unit of the largest tertiary hospital in Bangladesh. Front Microbiol 2020;11:612020.
Hu F, Lin ML, Mou JL, Feng JH, Huang K, Lao YJ, et al. Molecular and clinical characteristics of carbapenem-resistant klebsiella pneumoniae isolates at a tertiary hospital in Wuhan, China. Infect Drug Resist 2023;16:65-76.
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